Abortion’s Racial Gap

In 2005, Renee Bracey Sherman, then 19, sat in the abortion clinic alone. A jumble of concerns ran through her mind. She didn’t feel ready for a baby, but still, she worried that her parents would be disappointed in her choice. More than anything, though, she didn’t want to be a statistic, another pregnant black teen. “In the moment, you never know who your allies are,” Sherman said. “You don’t want to take the chance of everyone judging you at a moment when you’re so vulnerable. There’s a very unfortunate stereotype of women of color, and black women in particular, that we are promiscuous and just have babies. You don’t want that to be you.” An African-American woman is almost five times likelier to have an abortion than a white woman, and a Latina more than twice as likely, according to the Centers for Disease Control and Prevention. The rate of abortion among American women is currently at its lowest point since Roe v. Wade, according to a recent report by the Guttmacher Institute. About 1.1 million abortions were performed in 2011, at a rate of 16.9 abortions for every 1,000 women of childbearing age, down from a peak of 29.3 per 1,000 in 1981. Since the report’s release in February, the reason why has been the subject of much debate. Its authors and abortion-rights supporters point to the increase in contraceptive use and sexual education, while anti-abortion activists counter that the decrease is a result of abstinence-only teachings and state restrictions. Largely missing from the debate, though, is discussion of abortion’s racial disparity: Although rates among Hispanic and African-American women have decreased along with the rest of the country, they remain significantly higher than the national average. Christine Dehlendorf, a professor of family and community medicine at the University of California, San Francisco (UCSF) who specializes in reproductive health research, said that the discrepancy is reflective of the broader inequities people of color face in every arena. “There are a multitude of reasons, and we don’t fully understand what’s going on,” Dehlendorf said. “But ultimately I think it’s about structural determinants— economic reasons, issues related to racism, differences in opportunities, differences in social and historical context.” She emphasized that money is often a decisive factor. The median wealth of white households is 18 times that of Hispanic households and 20 times that of black households, according to the Pew Research Center, but across the board, low-income women have a higher rate of unintended pregnancy and abortion regardless of race. They are less likely to have health insurance or consistent access to healthcare, and therefore birth control, according to a study by the Kaiser Family Foundation. The Guttmacher report credited the increase in popularity of contraceptive intrauterine devices (IUDs) with contributing to the decline of the abortion rate. IUDs are among the longest-lasting and most effective methods of birth control—but they’re also among the most expensive, and therefore not an option for many low-income women. Yet black women still have higher rates of abortion even when controlling for income, according to a 2008 report by the Guttmacher Institute. At almost every income level, African-Americans have higher unintended pregnancy and abortion rates than whites or Hispanics. Sherman’s own experience echoes this finding: She grew up in a middle-class household, with college-educated parents, but still, she and many of her cousins and friends became pregnant during their teenage years. This is because controlling for income still fails to take into account other disadvantages that minority women experience, according to Dehlendorf, though there is little data on how these factors relate to unintended pregnancy. “It is important to remember that income is not equal to socioeconomic status—history, culture, education, wealth, family education and so on all contribute to this,” Dehlendorf said. “So you can’t say that by controlling for income you are taking away the effect of socioeconomic status.” Reproductive decisions often made for economic reasons can also be reinforced by social networks and group behavior, said UCSF public-health professor Ushma Upadhyay, citing the preference for condoms among African-American women. The only demographic in which African-Americans do not have the highest abortion rate is among women below the poverty line, where Latinas come in first. Upadhyay attributed this to language and cultural barriers that may limit poorer recent immigrants’ ability to obtain birth control, as well as a fear of legal repercussions among those that are undocumented. On average, black and Hispanic adolescents receive less thorough educations on reproductive health and birth control than their white counterparts within the same income bracket, according to a study co-authored by Dhelendorf and published last year in the American Journal of Public Health. The same study also noted that some women of color report experiencing pressure from their doctors to use contraceptives and limit their family size. Such discrimination, the study speculated, may discourage them from seeking birth control and reproductive counsel altogether. Upadhyay and Dehlendorf believe that the Affordable Care Act will help reduce abortion among women of color by making contraception more affordable. Though national numbers are not yet available, Upadhyay said that her own doctor has seen a huge spike in demand for IUDs since the law went into effect. Nearly a decade after her abortion, Sherman also looks to the future. Now 28, she is pursuing a masters in public health at Cornell University. Her parents have been supportive since she told them about the abortion, Sherman says, but she’s still aware of the burdens that other women like her face. “There’s that pressure that society puts on you, and the way society treats people who get pregnant young or unintended, especially if they’re of color,” she said. “You have to decide whether or not to get an abortion. Then you’re damned if you do, damned if you don’t.” This article was originally published at http://www.theatlantic.com/health/archive/2014/09/abortions-racial-gap/380251/